Commercial screening tests not always indicated, ethical

Commercial screening tests marketed directly to the consumer are not always indicated or ethical, according to a recent opinion piece.

“The increasing availability of direct-to-consumer screening tests is undermining physician efforts to provide high-quality, cost-conscious screening services to patients through shared decision making,” wrote the authors, including Steven Weinberger, MD, FACP, ACP's CEO.

The authors acknowledge that some commercial screening tests have proven benefit but note that the way in which the tests are administered, outside the physician's office and without a physician's advice, can be problematic. Consumers may not be aware that an “abnormal” result on a screening test may lead to many more additional referrals and tests, they said.

Ethical considerations mandate the following minimum standards, they wrote:

• Direct-to-consumer screening companies should state openly for whom screening tests are indicated according to published, evidence-based guidelines.
• Companies should fully inform customers about the potential risks and benefits of positive and negative results before tests are performed.
• Medical organizations, hospitals and physicians should not sponsor health screenings by commercial companies that offer unproven or harmful testing, as doing so represents a clear conflict of interest.

“If screening asymptomatic persons in the general population with nonindicated tests neither is medically beneficial nor enhances behavior change, how can it be ethical to allow marketing of such tests to the public?” the authors wrote. “We believe that promoting and selling nonbeneficial testing violates the ethical principles of beneficence and nonmalificence.”

The authors stressed that they respect patients' autonomy to make their own decisions but said that these decisions should be informed by evidence.

“Judicious and appropriate use of preventive services can certainly improve the health of our population and lower overall health care costs. However, misuse of preventive services, under the guise of saving lives and saving costs, may actually lead to increased cost and harm due to unnecessary follow-up testing and treatment with associated avoidable complications,” the authors wrote. “We suggest that medical entities and physicians withdraw from the unethical business of promoting unproven and potentially harmful screening tests.”

The full text of the article, which was published Aug. 28 by Annals of Internal Medicine, is available online. More information on ACP's High Value, Cost-Conscious Care Initiative is available on the College's website.